PURPOSE: This study aims to review gallbladder cancer (GBC) and present current management strategies, factors influencing prognosis, recurrence and areas of consideration. METHODOLOGY: Literature search in PubMed was made and restricted to articles published from 2002 to 2013 using the following keywords: (GBC + peritoneum and GBC + surgery + metastasis/recurrence); abstract evaluation narrowed results to 53 articles. Twenty-six single-institution reports with 2,097 patients among 36 large-scale retrospective studies were obtained and focused on surgical outcomes. RESULTS: GBC presents late and recurs early with a poor prognosis. There is no definitive time for curative re-resection following incidental diagnosis. Effective surgical strategies for each disease stage remain unclear. Management guidelines are not universally standardised, most institutions utilise protocols based on individual experiences and limitations. Early-stage GBC is curable with complete resection but invisible metastases at unobvious sites remain problematic. In this study, at least 450 patients relapsed, most had peritoneal metastasis. The peritoneum is a common metastatic site, its microenvironment is intrinsically hypoxic, well vascularized and lined with mesothelium overlaying immune aggregates, which express pro-angiogenic and adhesion molecules that are highly selective for tumour growth and evolution. There are no medical/molecular antagonists to inhibit peritoneal carcinomatosis. Peritonectomies have been successfully undertaken; furthermore, GBC responds to some chemotherapy combinations. CONCLUSION: This review focused on GBC surgery. Peritoneal carcinomatosis is common. In carefully selected patients, the incorporation of peritoneal disease in cytoreductive surgery and intraperitoneal chemotherapy will inhibit a vehicle for dissemination, eliminate future relapse sites and improve survival. Areas for consideration include universally standardised protocols, clear management guidelines for each stage, effective re-resection timings with guidance on where or how to identify additional disease.
PURPOSE: This study aims to review gallbladder cancer (GBC) and present current management strategies, factors influencing prognosis, recurrence and areas of consideration. METHODOLOGY: Literature search in PubMed was made and restricted to articles published from 2002 to 2013 using the following keywords: (GBC + peritoneum and GBC + surgery + metastasis/recurrence); abstract evaluation narrowed results to 53 articles. Twenty-six single-institution reports with 2,097 patients among 36 large-scale retrospective studies were obtained and focused on surgical outcomes. RESULTS: GBC presents late and recurs early with a poor prognosis. There is no definitive time for curative re-resection following incidental diagnosis. Effective surgical strategies for each disease stage remain unclear. Management guidelines are not universally standardised, most institutions utilise protocols based on individual experiences and limitations. Early-stage GBC is curable with complete resection but invisible metastases at unobvious sites remain problematic. In this study, at least 450 patients relapsed, most had peritoneal metastasis. The peritoneum is a common metastatic site, its microenvironment is intrinsically hypoxic, well vascularized and lined with mesothelium overlaying immune aggregates, which express pro-angiogenic and adhesion molecules that are highly selective for tumour growth and evolution. There are no medical/molecular antagonists to inhibit peritoneal carcinomatosis. Peritonectomies have been successfully undertaken; furthermore, GBC responds to some chemotherapy combinations. CONCLUSION: This review focused on GBC surgery. Peritoneal carcinomatosis is common. In carefully selected patients, the incorporation of peritoneal disease in cytoreductive surgery and intraperitoneal chemotherapy will inhibit a vehicle for dissemination, eliminate future relapse sites and improve survival. Areas for consideration include universally standardised protocols, clear management guidelines for each stage, effective re-resection timings with guidance on where or how to identify additional disease.
Authors: Juan Valle; Harpreet Wasan; Daniel H Palmer; David Cunningham; Alan Anthoney; Anthony Maraveyas; Srinivasan Madhusudan; Tim Iveson; Sharon Hughes; Stephen P Pereira; Michael Roughton; John Bridgewater Journal: N Engl J Med Date: 2010-04-08 Impact factor: 91.245
Authors: Eric H Jensen; Anasooya Abraham; Elizabeth B Habermann; Waddah B Al-Refaie; Selwyn M Vickers; Beth A Virnig; Todd M Tuttle Journal: J Gastrointest Surg Date: 2008-12-13 Impact factor: 3.452
Authors: William R Jarnagin; Leyo Ruo; Sarah A Little; David Klimstra; Michael D'Angelica; Ronald P DeMatteo; Raquel Wagman; Leslie H Blumgart; Yuman Fong Journal: Cancer Date: 2003-10-15 Impact factor: 6.860